Title GV, Government Code

Sec. 526.0054. PRIOR AUTHORIZATION FOR HIGH-COST MEDICAL SERVICES AND PROCEDURES. (a) The commission may: (1) evaluate and implement, as appropriate, procedures, policies, and methodologies to require prior authorization for high-cost medical services and procedures; and (2) cont…

Sec. 526.0055. TAILORED BENEFIT PACKAGES FOR NON-MEDICAID POPULATIONS. (a) The commission shall identify state or federal non-Medicaid programs that provide health care services to individuals whose health care needs could be met by providing customized benefits through a system …

Sec. 526.0056. PILOT PROGRAM TO PREVENT SPREAD OF INFECTIOUS OR COMMUNICABLE DISEASES. The commission may provide guidance to the local health authority of Bexar County in establishing a pilot program funded by the county to prevent the spread of HIV, hepatitis B, hepatitis C, an…

Sec. 526.0057. APPLICATION REQUIREMENT FOR COLONIAS PROJECTS. (a) In this section, "colonia" means a geographic area that: (1) is an economically distressed area as defined by Section 17.921, Water Code; (2) is located in a county any part of which is within 62 miles of an intern…

Sec. 526.0058. RULES REGARDING REFUGEE RESETTLEMENT. (a) In this section, "local resettlement agency" and "national voluntary agency" have the meanings assigned by 45 C.F.R. Section 400.2. (b) The executive commissioner shall adopt rules to ensure that: (1) any refugee placement …

Sec. 526.0059. PROHIBITED AWARD OF CONTRACTS TO MANAGED CARE ORGANIZATIONS FOR CERTAIN CRIMINAL CONVICTIONS. The commission may not contract with a managed care organization, including a health maintenance organization, or a pharmacy benefit manager if, in the preceding three yea…

Sec. 526.0101. DEFINITION. In this subchapter, "waiver" means the Texas Healthcare Transformation and Quality Improvement Program waiver issued under Section 1115 of the Social Security Act (42 U.S.C. Section 1315). Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1…

Sec. 526.0102. OPERATIONAL PLAN TO COORDINATE MAJOR QUALITY INITIATIVES. (a) The commission shall develop and implement a comprehensive, coordinated operational plan to ensure a consistent approach across the major quality initiatives of the health and human services system for i…

Sec. 526.0103. REVISION AND EVALUATION OF MAJOR QUALITY INITIATIVES. Notwithstanding other law, the commission shall revise major quality initiatives of the health and human services system in accordance with the operational plan and health care quality improvement goals develope…

Sec. 526.0104. INCENTIVES FOR MAJOR QUALITY INITIATIVE COORDINATION. The commission shall consider and, if appropriate, develop in accordance with this subchapter, incentives that promote coordination among the various major quality initiatives, including projects and initiatives…

Sec. 526.0151. DEFINITION. In this subchapter, "fund" means the Texas health opportunity pool trust fund established under Section 526.0153. Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.

Sec. 526.0152. AUTHORITY TO OBTAIN FEDERAL WAIVER. (a) The executive commissioner may seek a waiver under Section 1115 of the Social Security Act (42 U.S.C. Section 1315) to the state Medicaid plan to allow the commission to more efficiently and effectively use federal money paid…

Sec. 526.0153. TEXAS HEALTH OPPORTUNITY POOL TRUST FUND ESTABLISHED. (a) Subject to approval of the waiver authorized by Section 526.0152, the Texas health opportunity pool trust fund is created as a trust fund outside the state treasury to be held by the comptroller and administ…

Sec. 526.0154. DEPOSITS TO FUND. (a) The comptroller shall deposit in the fund: (1) federal money provided to this state under the disproportionate share hospitals supplemental payment program, the hospital upper payment limit supplemental payment program, or both, other than mon…

Sec. 526.0155. USE OF FUND IN GENERAL; RULES FOR ALLOCATION. (a) Except as otherwise provided by the terms of a waiver authorized by Section 526.0152, money in the fund may be used: (1) subject to Section 526.0156, to provide to health care providers reimbursements that: (A) are …

Sec. 526.0156. REIMBURSEMENTS FOR UNCOMPENSATED HEALTH CARE COSTS. (a) Except as otherwise provided by the terms of a waiver authorized by Section 526.0152 and subject to Subsections (b) and (c), money in the fund may be allocated to hospitals in this state and political subdivis…

Sec. 526.0157. INCREASING ACCESS TO HEALTH BENEFITS COVERAGE. (a) Except as otherwise provided by the terms of a waiver authorized by Section 526.0152, money in the fund that is available to reduce the number of individuals in this state who do not have health benefits coverage o…

Sec. 526.0158. INFRASTRUCTURE IMPROVEMENTS. (a) Except as otherwise provided by the terms of a waiver authorized by Section 526.0152 and subject to Subsection (c), money in the fund may be used for purposes related to developing and implementing initiatives to improve the infrast…

Sec. 526.0201. DEFINITION. In this subchapter, "council" means the Long-Term Care Facilities Council. Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.

Sec. 526.0202. INFORMAL DISPUTE RESOLUTION FOR CERTAIN LONG-TERM CARE FACILITIES. (a) The executive commissioner by rule shall establish an informal dispute resolution process in accordance with this section. The process must: (1) provide for adjudication by an appropriate disint…

Sec. 526.0203. LONG-TERM CARE FACILITIES COUNCIL. (a) In this section, "long-term care facility" means a facility subject to regulation under Section 32.021(d), Human Resources Code, or Chapter 242, 247, or 252, Health and Safety Code. (b) The executive commissioner shall establi…

Sec. 526.0204. COUNCIL DUTIES; REPORT. (a) In this section, "long-term care facility" has the meaning assigned by Section 526.0203. (b) The council shall: (1) study and make recommendations regarding a consistent survey and informal dispute resolution process for long-term care f…

Sec. 526.0251. RULES. The executive commissioner shall adopt rules providing for: (1) a standard definition of "uncompensated hospital care"; (2) a methodology for hospitals in this state to use in computing the cost of uncompensated hospital care that incorporates a standard set…

Sec. 526.0252. NOTICE OF FAILURE TO REPORT; ADMINISTRATIVE PENALTY. (a) The commission shall notify the attorney general of a hospital's failure to report the cost of uncompensated hospital care on or before the report due date in accordance with rules adopted under Section 526.0…

Sec. 526.0253. NOTICE OF INCOMPLETE OR INACCURATE REPORT; ADMINISTRATIVE PENALTY. (a) If the commission determines that a hospital submitted a report with incomplete or inaccurate information using a procedure adopted under Section 526.0251(3), the commission shall: (1) notify th…

Sec. 526.0254. REQUIREMENTS FOR ATTORNEY GENERAL NOTIFICATION. The commission's notification to the attorney general under Section 526.0252 or 526.0253 must include the facts on which the commission based the determination that the hospital failed to submit a report or failed to …

Sec. 526.0255. ATTORNEY GENERAL NOTICE TO HOSPITAL. The attorney general shall give written notice of the commission's notification to the attorney general under Section 526.0252 or 526.0253 to the hospital that is the subject of the notification. The notice must include: (1) a b…

Sec. 526.0256. PENALTY PAID OR HEARING REQUESTED. Not later than the 20th day after the date the attorney general sends the notice under Section 526.0255, the hospital receiving the notice must submit a written request for a hearing or remit the amount of the administrative penal…

Sec. 526.0257. HEARING. (a) If a hospital requests a hearing in accordance with Section 526.0256, the attorney general shall conduct the hearing in accordance with Chapter 2001. (b) If the hearing results in a finding that a violation has occurred, the attorney general shall: (1)…

Sec. 526.0258. OPTIONS FOLLOWING DECISION: PAY OR APPEAL. Not later than the 30th day after the date the hospital receives the order entered by the attorney general under Section 526.0257, the hospital shall: (1) pay the amount of the administrative penalty; (2) remit the amount …

Sec. 526.0259. DECISION BY COURT. (a) If a hospital paid an administrative penalty imposed under this subchapter and on review a court does not sustain the occurrence of the violation or finds that the amount of the penalty should be reduced, the attorney general shall remit the …

Sec. 526.0260. RECOVERY OF PENALTY. If a hospital does not pay the amount of an administrative penalty imposed under this subchapter after the attorney general's order becomes final for all purposes, the attorney general may enforce the penalty as provided by law for legal judgme…

Sec. 526.0301. STRATEGIC PLAN FOR RURAL HOSPITAL SERVICES; REPORT. (a) The commission shall develop and implement a strategic plan to ensure that the citizens in this state residing in rural areas have access to hospital services. (b) The strategic plan must include: (1) a propos…

Sec. 526.0302. RURAL HOSPITAL ADVISORY COMMITTEE. (a) The commission shall establish the rural hospital advisory committee, either as an advisory committee or as a subcommittee of the hospital payment advisory committee, to advise the commission on issues relating specifically to…

Sec. 526.0303. COLLABORATION WITH OFFICE OF RURAL AFFAIRS. The commission shall collaborate with the Office of Rural Affairs to ensure that this state is pursuing to the fullest extent possible federal grants, funding opportunities, and support programs available to rural hospita…

Sec. 526.0304. STATE OFFICE OF RURAL HOSPITAL FINANCE. The commission shall establish and maintain the State Office of Rural Hospital Finance within the commission to provide technical assistance for rural hospitals and health care systems in rural areas of this state that partic…

Sec. 526.0305. TEXAS RURAL HOSPITAL OFFICERS ACADEMY. (a) In this section: (1) "Institution of higher education" has the meaning assigned by Section 61.003, Education Code. (2) "Rural county" means a county with a population of 68,750 or less. (3) "Rural hospital" has the meaning…

Sec. 526.0321. DEFINITIONS. In this subchapter: (1) "Hospital district" means a hospital district created under the authority of Sections 4 through 11, Article IX, Texas Constitution. (2) "Office" means the State Office of Rural Hospital Finance established under Section 526.0304…

Sec. 526.0322. FINANCIAL STABILIZATION GRANT PROGRAM. (a) The commission shall establish a financial stabilization grant program to award grants to support and improve the financial stability of rural hospitals, rural hospital districts, and rural hospital authorities that are de…

Sec. 526.0323. EMERGENCY HARDSHIP GRANT PROGRAM. (a) The commission shall establish an emergency hardship grant program. (b) The office may award emergency hardship grants to rural hospitals, rural hospital districts, and rural hospital authorities that have experienced: (1) a ma…

Sec. 526.0324. INNOVATION GRANT PROGRAM. (a) The commission shall establish an innovation grant program to provide support to rural hospitals, rural hospital districts, and rural hospital authorities that undertake initiatives: (1) to provide access to health care and improve the…

Sec. 526.0325. RURAL HOSPITAL SUPPORT GRANT PROGRAM. The commission shall establish a rural hospital support grant program to award support grants to rural hospitals, rural hospital districts, rural hospital authorities, and rural hospital organizations to improve the financial s…

Sec. 526.0326. GENERAL GRANT PROVISIONS. (a) Chapter 783 does not apply to the solicitation of applicants for a grant under this subchapter. (b) To the extent practicable, the office shall award a grant under this subchapter not later than the 180th day after the date the office …

Sec. 526.0327. LIMITATION ON CONTROL OF FUNDS BY HOSPITAL SYSTEM. (a) For purposes of this section: (1) "Control" includes the ability to make decisions regarding the time and manner in which to spend grant money awarded under this subchapter. (2) "Hospital system" means a system…

Sec. 526.0328. APPROPRIATION CONTINGENCY. The commission is required to implement a provision of this subchapter only if the legislature appropriates money specifically for that purpose. Added by Acts 2025, 89th Leg., R.S., Ch. 707 (H.B. 18), Sec. 4, eff. June 20, 2025. SUBCHAPTE…

Sec. 526.0351. DEFINITIONS. In this subchapter: (1) "Medical transportation program" means the program that provides nonemergency transportation services to recipients under Medicaid, subject to Section 526.0353, the children with special health care needs program, and the transp…